Case Report of a Large Ovarian Cyst in a Multiparous Woman: A Challenging Surgical Management

This case report details the surgical management of a large (15 × 9 cm) symptomatic right ovarian cyst in a 42-year-old multiparous woman, highlighting the decision-making process for definitive treatment. The patient presented with chronic pelvic pain and a palpable mass, significantly reducing her quality of life. Imaging revealed a large, multilocular, benign-appearing cystic lesion. Given the patient's age, completion of childbearing, and the cyst's size and complexity, a right salpingo-oophorectomy was performed instead of a cystectomy to achieve definitive symptom resolution and mitigate recurrence risk. The decision to proceed with a definitive right salpingo-oophorectomy, rather than an ovarian cystectomy, was based on a confluence of factors: the patient's age (42), her status as a multiparous woman who had completed childbearing, and the cyst's size and complex multilocular morphology which increased the technical difficulty and potential morbidity of cystectomy while raising a low-grade concern for underlying neoplasia. The surgery was uncomplicated, and histopathology confirmed a benign cystadenoma. This case underscores the importance of tailoring surgical intervention, specifically the choice between cystectomy and salpingo-oophorectomy, to individual patient factors such as parity, fertility goals, and cyst characteristics to optimize clinical outcomes.